Provider Demographics
NPI:1174508428
Name:GOUKER, RONALD E (DC CSCS CCSP)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:E
Last Name:GOUKER
Suffix:
Gender:M
Credentials:DC CSCS CCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 METRO PLZ
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15401-5407
Mailing Address - Country:US
Mailing Address - Phone:724-437-8800
Mailing Address - Fax:724-437-8805
Practice Address - Street 1:15 METRO PLZ
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-5407
Practice Address - Country:US
Practice Address - Phone:724-437-8800
Practice Address - Fax:724-437-8805
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC 007421 L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01788791Medicaid
066221Medicare ID - Type Unspecified
U77170Medicare UPIN